Program Specialist III – Fair Hearings Coordinator III

 
The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist III. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by providing oversight and monitoring of all fair hearing applications associated for Individual Plan of Care reviews in Utilization Review.

The Program Specialist III position completes highly complex oversight and technical assistance related to fair hearings for appeals in the following waivers: Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and Deaf Blind with Multiple Disabilities (DBMD).  The position provides fair hearing support to the utilization review department, appellants including individuals, legal guardians or their legal representation, and provider groups.

The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

This position reports to the Director of the IDD Waivers Unit of Utilization Review. 

Conducts routine monitoring, analysis and processing of hearing requests including reviewing fair hearing requests for required documentation, uploading information into the hearing’s portal, providing needed documentation to the Fair Hearing’s department, and scheduling fair hearings through outlook for participating staff. Coordinates special projects related to fair hearings at the direction of management and provides technical program assistance to HHSC staff, management and the Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD) provider groups, advocacy groups, stakeholders, individuals who receive program services and their families. Provides technical assistance regarding fair hearing requests for appeals related to reduction or denial of services in Individual Plans of Care (IPC). Assists, as directed, in the collection of data and preparation of information in response to individual, provider, agency and interagency request for information as well as in the collection, maintenance and preparation of information required for federal and other reporting purposes. The position performs complex technical work with minimal supervision. The position establishes and maintains effective working relationships with managers, supervisors, coworkers and the public and answers questions on agency or program activities related to fair hearings.   

ESSENTIAL JOB FUNCTIONS: 
Conducts routine monitoring, analysis and processing of hearing requests including reviewing fair hearing requests for required documentation, uploading information into the hearing’s portal, providing needed documentation to the Fair Hearing’s department, and scheduling fair hearings through outlook for participating staff. (25%)

Reviews, monitors, evaluates and processes deliverables upon the completion of fair hearings regarding instructions from fair hearing officers, and documentation to show orders have been carried out (e.g., fair hearing orders, documenting requirement completions in the data system). (20%)

Provides consultative services and technical assistance on a complex level to management, HHSC staff, provider community staff and other stakeholders regarding fair hearings. (20%)

Conducts analysis of data and reports in response to requests for program information or special project reports. (10%)

Coordinates legal representation from the HHSC litigation department, including providing required documents and forms such as releases and evidence packets, and schedules required meetings for litigation preparation for fair hearings.  (5%)

Provides consultative services and communicates with stakeholders, other governmental agencies, community organizations and the general public on the fair hearing process.  (5%)

Maintains repositories of process outcomes and other work products producing scheduled written summations of that information when requested. (5%)

Conducts testing in HHSC data systems. (5%)

Participates in scheduled Fair Hearings and Administrative Reviews requested by the individual or legally authorized representative when assigned. (5%).

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.